Confidentiality: All information provided will be kept strictly confidential. First Name: (Required) Last Name: (Required) State Where You Live: North Carolina Residents Only County Where You Live: (Required) Select Your County Alamance Alexander Alleghany Anson Ashe Avery Beaufort Bertie Bladen Brunswick Buncombe Burke Cabarrus Caldwell Camden Carteret Caswell Catawba Chatham Cherokee Chowan Clay Cleveland Columbus Craven Cumberland Currituck Dare Davidson Davie Duplin Durham Edgecombe Forsyth Franklin Gaston Gates Graham Granville Guilford Halifax Harnett Haywood Henderson Hertford Hoke Hyde Iredell Jackson Johnston Jones Lee Lenoir Lincoln Macon Madison Martin McDowell Mecklenburg Mitchell Montgomery Moore Nash New Hanover Northhampton Onslow Orange Pamlico Pasquotank Pender Perquimans Person Pitt Polk Randolph Richmond Robeson Rockingham Rowan Rutherford Sampson Scotland Stanly Stokes Surry Swain Transylvania Tyrrell Union Vance Wake Warren Washington Watauga Wayne Wilkes Wilson Yadkin What Date Is Best For You? Select Best Date For You Tomorrow In 2 days In 3 days Next Week On a Saturday (Not always available) Other What Time Is Best For You? Select Best Time For You 7 am 7:30 am 8 am 8:30 am 9 am 9:30 am 10 am 10:30 am 11 am 11:30 am 12 pm 12:30 pm 1 pm 1:30 pm 2 pm 2:30 pm 3 pm 3:30 pm 4 pm Which Do You Want? Face-To-Face Consultation Over-The-Phone Consultation Your Email Address? In case we can't get in touch by phone. Your Best Phone Number:(Required) Your Next Best Phone Number: Best Time To Call: (Required) Select Best Time To Call You Anytime Immediately Morning (8 am to 10 am) Morning (10 am to 12 noon) Afternoon (12 noon to 2 pm) Afternoon (2pm to 4 pm) Afternoon (4pm to 6 pm) Evening (6 pm to 8 pm) Weekends Would you like to tell us something about your situation? If so, please fill in the following boxes. (This following information is NOT required.) Please tell us a little about your situation What are your biggest problems? What would you like to see happen? Total Unsecured Debt You Have? $ A rough estimate of the total is O.K. Unsecured debts are debts like credit cards, medical bills, finance companies, and personal loans, where none of your property listed as "collateral". Total Monthly Minimum Payments? $ If you had the money to pay on all your unsecured debts on time each month, how much would the minimum payments add up to. Just give us an approximate amount. Is it $300 per month? $500 per month? $1,000 per month? More? Are you behind on a House or Vehicle you want to keep? Yes No If so, how many months are you behind?